Introduction and Purpose

Answer

Chapter 1: Introduction and Purpose

Background

Sepsis is considered a life-threatening condition which occurs as acute depending on the type of the infection or source of infection. As explained by White & Witts (2016), sepsis is a systemic disease occurring from infection and over activation of the essential immune system known as Systemic Inflammatory Response Syndrome (SIRS). Patients with chronic wounds and improper management of wounds are at high risk of infection and possible sepsis. In the United Kingdom, approximately11.5% of sepsis-related deaths included leg ulcers shown in ICD-10 codes as reported by White & Witts (2016). In addition, patients with chronic pressure ulcers stage III and IV are considered to be high risk for sepsis so they require close monitoring for signs and symptoms of infection when care for a wound is provided by the nursing staff (White &Witts, 2016).

At current facility, California Correctional Healthcare Facility (CCHCF), the patient population consists of inmates in which many patients are paraplegic, diabetic or have peripheral insufficiency and suffer from chronic wounds and complications related to them. Knowledge deficit and early recognition are very critical issues at the CCHCF on behalf of the nurses. Due to insufficient knowledge of signs and symptoms of sepsis, the nurses miss the early signs and symptoms which places the patient at high risk of more serious health complications. According to Analysis of 2017 CCHCF Death Reviews (2018), there were 2 preventable cases of sepsis-related deaths that included necrotizing cervical fasciitis and other skin infection. After the analysis, it was determined that it was due to the lack of recognizing and evaluating the important signs and symptoms and delay in failure in emergency response (Imai, 2018).

Problem Statement

Nurses are considered to be the frontline workers in healthcare in providing efficient and adequate care to the patients. Adequate knowledge and skills according to the specialty of the work area is required by the facilities for the nurses to be proficient. When nurses are able to recognize possible signs and symptoms of sepsis, the nurse can alert the physician promptly and have the physician start the treatment, order lab work and close monitoring of the patient to prevent further complications. Moreover, the IP can be transferred to a higher level of care within the facility where more nursing care can be provided per IP needs.

At CCHCF, there is no specialty and all care provided is considered to be under the generalized umbrella of care. Nurses caring for patients with cardiac, renal, hepatic, neurological, critical wounds and more have all the same level of skills which includes nurses who have never worked in acute care, new graduates, and the only experience includes longer-term rehabilitation.  The nurses requiring no special training or certification can place specific patients at risk for further health complications. As a prudent nurse, one would take time to learn more of the patient condition or if something new is encountered but not every nurse will do that.

Currently, at CCHCF, there are many patients who have chronic wounds which do get infected and lead to further complications such as sepsis. Most of these patients are able to verbalize when there is something wrong with them, change of condition or believe they may be getting an infection. The floor nurses may not be proactive and not listen to what the IP has to say about their signs and symptoms due to the type of work environment or mentality of the nurses. As explained by White & Witts (2016), all healthcare providers including nurses and physicians should act promptly when a patient presents signs and symptoms of wound infection which can become fatal infection such as sepsis or even extensive tissue necrosis.

Furthermore, during the nursing practicum, nurses were observed not taking precautions or following the appropriate wound care orders. Some of the nurses were also observed not reporting any change to the wound which also further delayed prompt action on nursing and medical part.  Nurses are seen reluctant to report worsening or change of condition because some feel incompetent with their skills and some don’t want to add more work to their already daily routine. As a nurse, it is pertinent to report any abnormal finding to the physician and collaborate on a new plan of care due to worsening of wound status. Not communicating the findings to the physicians also places the patient at high risk of having the infection which can also become systemic. Nurses are the first line of an advocate for the patients that see the patient on a daily basis and recognize changes quickly and efficiently if competent in their skills.

The Purpose of Change Proposal

The project consists of educating the nursing staff of CCHCF on simple and complex wounds, signs and symptoms of generalized infection and recognizing sepsis early in its stages. With proper training and knowledge of how to treat wounds, it will allow avoidance and/or early recognition of sepsis leading to prompt treatment. More importantly, knowing signs and symptoms of sepsis, early recognition, and how it can be prevented will allow eliminating worsening of health, and lower the cost of medical care provided for a treatment that can be prevented. Nurses will further be educated on the use of electronic health record-Cerner used by the facility. Familiarity and education of Cerner will include how to properly document within an appropriate flow chart in the patient chart for wound care. Education will also include how to effectively communicate between nursing and medical staff.  Nurses being competent in the documentation, how to recognize signs/symptoms will allow nurses to be more comfortable with their own assessment and skills and allow to provide the care necessary.

The project is focused on educating the facility nurses for better assessment skills and ways to recognize the s/s of sepsis secondary to wound infection. This will benefit both the nursing staff in limiting complications related to wound infection such as sepsis and patient in proper wound care management. Moreover, the patient will benefit from nursing being efficient in catching sepsis in the early stages and being able to treat the problem in the facility instead of having to go to an outside hospital for sepsis treatment. Detecting early signs and symptoms of sepsis will help the patient from acquiring any possible preventable chronic organ damage.

If nurses are properly educated and are able to prevent the patients from having to be admitted in an outside community hospital, the facility can also save a lot of money and utilize that money for improvement in the facility. Sepsis is not being recognized in its early stages and IPs are being admitted to hospital for treatment, increasing facility cost and budget. Usually, when an IP is sent to the hospital for treatment, two officers are required to keep watch at all times plus the cost of the ambulance and depending on days the IP is in the hospital, it can accumulate very high.

In order to meet the gaps in existing nursing knowledge, it is crucial to learn of the nursing barriers and planning to overcome those barriers. Furthermore, assessing the knowledge and skills of the nurses can lead to better presentation and education to nursing staff which in turn can be beneficial for inmate patients. Continuation of information review or refreshers courses related to how to recognize sepsis, proper wound care, and documentation should be made available to nurses during their annual nursing training.

PICOT Statement

Do adequate knowledge and proper nursing skills effective in decreasing cases of sepsis with chronic wounds?

Chapter 2: Literature Review

Content and Resources

The content and resources used for this research study were essentially derived from medical databases comprising peer reviewed journals and articles as well as websites that have sufficient information touching on the nature of septic wounds. The relevant terms used in the search engines included sepsis, septic wounds, patient care, wound healing process and proper care of wounds. The strategy used in the collection of information was to identify what causes sepsis and the type of care that is required to ensure that wounds do not turn septic. The selected sources used in this literature review were thus selected following the fact that they satisfied the criteria of explaining sepsis and how improper care in wound management would result in sepsis. This is essentially the basis of the study; to understand the nature of sepsis and how the situation escalates in the event that wound management is poorly executed.

Evidence-Cause and Effect Relation between Improper Wound Management

From research, there is evidence suggesting that the presence of a cause and effect relation between improper wound management and the development of sepsis. According to the journal of surgical research, several complications are bound to arise from improper management of a wound. One of the most dangerous complications is the manifestation of sepsis. Sepsis inflammation can cause a widespread effect on the body that damages other organs and prolongs wound healing process. Wound management involves a wide range of simple clinical measures to protect, cover and administration of medicine. However, neglect of infection is most likely to worsen the situation to allow for the spread of the wound infection and even become deadly. Several efforts have been put in place over a significant period of time to study, analyze, synthesize and report on the development of sepsis as a result of improper wound management. Such reports are both complimentary and somewhat argumentative on the causal and effect relationship. This review looks into various scholarly articles that give evidence to the affirmative.

Dynamics of Wound

It is essential to understand the dynamics of the wound so as to define what entails proper wound management and improper wound management. According to Bowler, Duerden, and Armstrong (2001), in the majority of the wounds, there exist colonies of aerobic and anaerobic microorganisms. The authors highlight that these organisms originate from the mucosal surfaces and their role in the healing process are seriously debatable. Some sections of experts claim that the concentration of the microbes is significant in the wound restorative process. However, other experts argue that the microbial concentration is a minor issue and that other influences such as the immunity of the patient, microbial synergy and quality of tissues weigh more in determining the probability of infection. Primarily, the function of the skin is to regulate the microbial population and prevent them from accessing the inner tissues. Therefore, proper wound coverage as well as treatment, helps prevent damage from microbial activity.

Wound Healing Process

Another critical aspect of wound management is understanding the wound healing process to differentiate a normal curative process from lingering non-healing wounds. For the nursing fraternity to properly take care of patients and treat wounds, it is imperative that they understand the wound healing process so as to inform on the treatment criteria. Velnar et al. (2009) highlight that the wound curing process is a challenging clinical problem. It involves the process of cellular populations and extracellular factors including complementary mediating factors such as cytokines as well as growth factors. The stages to healing, however, include the coagulation and homeostasis, inflammation, propagation, and scar formation. However, the correct approaches to wound treatment significantly affect the healing outcome.

The wound healing process, as stated earlier, is a delicate process and careful clinical measures need to be effected. However inadequate training and improper treatment measures can lead to the rise of Sepsis. There are no clear steps to improper wound management. However, certain lapses, assumptions, and utter ignorance constitute poor wound management. Rudich (1999) highlights that proper wound management begins from the time of treatment. Measures that are taken by healthcare specialists in covering, creating surgical incisions and dressing the wound affect the healing process as well as the duration of the healing process. The Advanced Tissue Company that supports the patients wound healing process through media-based technologies, a large number of patient population with wounds is overlooked. However, this category of patients requires specific care measures to avert the development of Sepsis. Nurses, being the primary caregivers, do play a significant role in preventing the development of wounds into chronic stages.

Sepsis Relationship to Wounds & Improperly Managed Wounds

Having defined Sepsis, it is important to identify its relationship to wounds and more especially the improperly managed wounds. Well managed chronic wounds that are subject to proper treatment and monitoring are less likely to develop Sepsis. However, for most chronic wounds, if not adequately looked after by patients and nurses, the manifestation of Sepsis is almost inevitable. Butler (2015) states that Capnocytophaga canimorsus is another emerging cause of sepsis that originates from bacterial pathogens contained in dog saliva and transmitted to humans through dog bites. Moreover, epidermal wound healing is significantly affected in Severe Sepsis, (Schultz, 2003). Systemic Sepsis infiltration is likely to manifest right from the first stages of the wound dressing process (Errede, 2013). As a result, improper wound dressing creates a poor microclimate for rapid and productive growth.

Measures to curb the development of Sepsis include early detection. Patients in their own capacities may not be in position detect the symptoms. However, primary caregivers should be equipped and well trained to detect its manifestation. According to Calvert et al. (2016), prediction of Sepsis can be made at least three hours in advance of its manifestation in a patient during the first five-hour SIRS episode. Some of the diagnosis methods include the computer-assisted diagnosis and clinical decision support criteria (Calvert, 2016). Monitoring of high-risk Sepsis patients with chronic wounds is highly recommended. Some of the symptoms and signs of Sepsis that can guide to early detection include recordings of systolic pressures less than or equal to 100mmHg, (Mayo Clinic, 2019) change in mental balance and respiratory rate higher or equal to 22 breaths per minute.

Early detection requires that the primary caregivers be equipped with some of the early detection techniques to handle emergencies before further medical treatment is advised. Early treatment of Sepsis entails the use of antibiotics as well as large amounts of intravenous fluids. Across the world, millions of emergency medical visits include sound care emergencies, (Alliance, 2019). These wounds result from a wide range of surgical procedures including medical operations, accidental ruptures and low immunity levels in some patients leading to the slow healing processes or simply post-surgical complications, (Nicks et al., 2010).

Research and Focus of Project

Measures to educate the nursing staff at CCHCF is a big move to reduce the medical costs incurred, but above all prevent the manifestation of Sepsis in patients many of whom have chronic wounds. Despite equipping personnel to detect signs and symptoms of Sepsis in its early stages, it is agreeable that prevention is a much better strategy to avert the condition from the onset. Therefore, the most popular prevention measure proposed is simply the proper wound dressing taking into consideration the adequate air flow, porosity as well as ease of cleaning. Some of the factors to be considered for a good wound covering according to (Zamierowski, 1990) include prevention of dehydration and scab formation, permeability for oxygen circulation, use of sterilized materials that are non-toxic and non-sensitizing.

The frequency of occurrence of Sepsis due to improper wound management cannot be directly defined since other variables affect the probability of occurrence. These variables include the age of the patient, levels of stress, nutritional state of a person, the presence of other diseases that weaken the immunity such as diabetes, alcoholism and smoking addictions and obesity, (Jacobi, 2002). These systemic factors if present accelerate the rate of manifestation of Sepsis for improperly handled chronic wounds. There are numerous models of sepsis (Mitchell, 2019), septic shocks are therefore not similar, and clinical tests cannot, therefore, be perfect, (Fink, 1990). As a result, the frequency of occurrence of a septic shock due to improper wound management cannot be directly predicted. This is because of the predispositions to the systemic factors which vary between patients.

Cause and Effect Relationship

The relationship between Sepsis and improper wound management is a cause and effect relationship. It is however not entirely apparent that all septic shocks result from inadequate treatment of wounds. Educating the primary caregivers on the consequences of poor wound management especially in a facility with patients that have chronic wounds, will help prevent the occurrence of sepsis. Detection of the early sign and administration of antibiotics is necessary to increase chances of survival, (Alliance, 2019). However, proper training of the primary caregivers boosts the ability of the medical facility to prevent and administer adequate treatment to patients.

The epidemiology of sepsis makes the situation critical especially for patients as it increases risk of infection and has been reported to be the cause of death for millions of people who have been hospitalized (Deutschmann & Tracey, 2014). Sutton and Friedman (2013) present reports that in the United States, patients who are released to have nursing care following their multiple sepsis conditions in the year 2010 were most likely to be readmitted into another care facility due to their condition. Hines et al. (2014), in their study of 18 states in the US revealed that among the top reasons for patients’ readmission was sepsis which affirms that improper care with regard to wound healing and care is bound to result into a severe case scenario in which the patient may not recover as is supposed to. According to their study, Koh et al. (2012) affirm that in a hospital setting, there are several factors that are bound to result in the development of sepsis. These factors may involve the use of certain medication as well as the improper care of wounds both open and closed to the detriment of the patient. Rubin and Schaffner (2014) ideally address the clinical practice of caring for a wound including the fact that with improper care of wounds results in a septic situation. Further, there are factors that accelerate and render a patient to be highly susceptible to sepsis such as age and conditions that primarily weaken the overall immune system such as cancer, diabetes and major trauma. This position is further advanced by Polat et al. (2017) in which the authors highlight how people with chronic illnesses and are primarily on immunosuppressive medication are prone to being affected by sepsis due to the inability of their body systems to create a proper balance in producing the necessary cytokines to help with the epithelialization and wound healing process.

Incidentally, the study surrounding sepsis has been found to be difficult to quantify and duly record following the fact that majority of the cases are not documented, especially for situations in which the patients suffer from cognitive decline from the frequent occurrence of the sepsis (Jackson, 2009). Practically, in the prognosis of sepsis, it has been found that the situation has the capacity to result in a variety of cases based on the severity and period in which an individual suffers with sepsis (Jackson, 2009). Critically septic patients according to Drewry et al. (2017) require certain level of care to ensure that their conditions improve and to avert the situation in which the sepsis spreads and becomes a loophole for the development and susceptibility of the patient to other illnesses. In the case of newborns, neonatal sepsis may be difficult to note as babies are essentially asymptomatic (Shane & Stoll, 2014). In this regard, it becomes difficult to treat babies for sepsis or in some cases the diagnosis is made late to the disadvantage of the health of the child (Kutko et al., 2003). Therefore, upon diagnosis, antibiotics are administered to the child until the source of the sepsis on the child’s system is identified and the sepsis is thus treated accordingly using the prescribed medication (Camacho-Gonzalez et al., 2013). In essence, it is imperative that proper care is advanced as the treatment for the sepsis may also trigger the need for treatment of other underlying conditions as a result of the septic condition of the patient (Drewry et al., 2017). While hospitals should be centers in which sepsis is handled with more accuracy, in many cases, it is the admitted patients who develop septic conditions that end up disrupting the healing process of wounds that are being treated (Russel, 2008).

Wounds if not well catered to have the capacity of advancing into being sepsis and thus creating a life threatening situation depending on their location of the body. Improper care has the capacity of rendering a small issue to accelerate to being a serious matter. According to studies done by Sommer et al. (2013), the nature of the development of septic wounds is that they are capable of rendering a patient to even be immobile and incapacitated due to the nature of the septic wound. Improper care ideally advances the need for surgery in order for a patient to be relieved of the pain that primarily emanates from the effects of septic wounds. This is further documented by Barriere and Lowry (1995) who further postulate that septic patients suffer a variety of complications that arise from impaired wound healing such as anastomotic leaks, facial dehiscence and infections. These complications have been found to be common among the septic patients and thus, it is prudent that necessary care is advanced and the health care providers are aware of the proper measures to take in attending to septic patients. Koskela et al. (2005) note that these complications give rise to further issues as septic patients often require surgery as an intervention to their condition which increases the risk of the wounds healing through complicated means. The development of a septic wound, especially after surgery, is significantly high. However, it is yet to be discovered and thoroughly looked into on the mechanisms that advance sepsis in wounds during the healing process as projected by Rico et al. (2002) in their study on the process of how wounds continue to heal. However, studies on the epidemiology and prognosis of sepsis try to shed insight on the occurrence and trigger factors of sepsis on patients even when the wound healing process is underway.

The process of wound healing involves the inflammation of tissues as they react to the damage that has been caused (Koskela et al., 2009). Ideally, the systemic inflammatory response that is experienced is usually disrupted in the event that the wound becomes septic (Santoro & Gaudino, 2005). The healing of a wound is usually regulated by the close presence of the cytokines which are responsible for the healing process. The cytokines are responsible for the formation of the granulation tissue and are also responsible for ensuring that the wound heals through epithelialization. The introduction of the tumor necrosis factor-alpha (TNF-α) through the regulation of the cytokines thus is influenced by the inflammation of the cytokines that results from the sepsis that alters the overall disruption of the wound healing process. Based on the findings of Weinstein and Kirsner (2010), the tumor necrosis factor-alpha (TNF-α) may be both beneficial and detrimental to the regulation of cytokine in the process of wound healing. Hence it suffices to consider the manner in which the cytokines are regulated in the granulation formation to determine the nature of the wound healing process. The regulation process is important as it affects the outcome of the wound healing process. This is such that, with the elevation of the tumor necrosis factor-alpha the granulation tissue production reduces in the process and the decreased production of the tumor necrosis factor-alpha results in the increased disposition of collagen (Steenfos, 1994). Gill and Parks (2008) in their work also affirm the position regarding the portions of the various factors that contribute to the regulation of the cytokines thus influencing the positive process of wound healing or the disruption due to sepsis. The standard levels have to be maintained in order for the wound healing process to be affected positively. It is the inflammation of the cytokines that ideally results in changes and leads to the disruption of the process, hence inhibiting positive wound healing thus sepsis develops.

Leask and Abraham (2004) highlight that the collagen production is influenced by the suppression of tumor growth factor-beta (TGF-β) by TNF-α. This essentially leads to the counteraction in the production of extracellular matrix (ECM). Tissue inhibitors lead to the low production of the matrix metalloproteinases (MMP) and regulation of tissue inhibitors of metalloproteinases (TIMP) resulting in the disruption of the wound healing process (Mahdavian et al, 2011). The significance of MMPs is vested in the fact that they influence the restoration of normal tissue architecture thus accelerating the wound healing process. In this regard, the MMPs are relevant in the formation of the epithelialization of tissues and scar formation thus resulting in the healing of a wound and advancing a situation in which sepsis is averted (Toriseva & Kahari, 2009). Marti et al. (2008) in their work acknowledge that sepsis has the effect of reducing the rate at which wounds heal. According to Greenhalgh and Gameli (1987) this is further made worse in the event that the septic wound is not particularly close to the source of the infection resulting in a situation where proper dressing and cleaning of the wound may not be as effective.

Chapter 3: Method

Description of Population

Nursing staff at CCHCF are the main participants of the project because the selected project focuses on educating the nursing staff in better wound care management and early detection of sepsis related to wound infection/complications. This project is in hopes to have positive outcomes in patient care related to wound management after the staff is adequately provided with education and knowledge related to wound management and early detection of sepsis.

The project was reviewed and approved by the nursing practicum mentor Cyrus Yanos who is the registered nurses at CCHCF. The writer completed the nursing practicum under RN Yanos supervision and approval of all material used for collecting the data and information.

Description of Design Type

The project initially was started with writing the objectives for the nursing practicum portion and what the individual wanted to achieve/accomplish. Once the objectives were approved by the nursing practicum mentor and instructor, the student started on creating the material and gathering the information. The first step of gathering the data was to learn of barriers faced by the nursing staff in providing adequate wound care to their patients which can potentially lead to wound complications and sepsis. This was important to learn for the direction of the project the student wants to take and focus on. After interviewing many nurses and receiving their feedback, a survey was created to check nursing knowledge/skills related to wound care consisting of wound care type solutions being used, types of wounds, stages of pressure ulcers, charting, and facility policy, and wound care team awareness. The survey also provided the fundamental of the project such as nursing knowledge and awareness related to wounds and gaps that need to be addressed for adequate care for the patients.

The survey was used to create the PowerPoint focusing mainly on the types of wounds, conducting the assessment, communication between staff, and utilizing wound care team nurses and facility policy to care for the patient. After getting the feedback from the nurses via the survey, the PowerPoint on wound care education for CCHCF nurses was created. The purpose of the PowerPoint was to help enhance the nursing knowledge on types of wounds, effective communication within the medical-nursing staff using Cerner and informing of wound care team at CCHCF as resource. The PowerPoint was presented by visiting different units and also by emailing the nurses.

After the presentation, a survey was passed out to the nurses to evaluate the effectiveness of the PowerPoint and to give any other feedback. This method was used to learn if the PowerPoint and information that was presented were helpful to the nurses in enhancing their knowledge related to wound care and familiarity with electronic charting using the facility acquired software Cerner. Since the feedback was positive from the nurses that the information presented helped them in learning especially the Cerner information to do effective documentation, assures that this education activity, in fact, was fruitful and positively effective.

Justification for Inclusion/Exclusion of Content

Inclusion of Content

The content that was included in the surveys, interview, and PowerPoint was to learn of nursing knowledge and skills, areas that require improvement and education on behalf of nursing staff. Furthermore, additional contents were added to the PowerPoint such as effective communications, use of Cerner application-area to document due to lack of nursing staff knowledge. Nursing staff should be able to effectively communicate between staff and medical provider when needed and should be able to compile the assessment in case there is a change to compare the results. Becoming familiar with the software being utilized by the facility can help overcome the barrier of ineffective communication.

Furthermore, being aware of the complications related to improper wound care can lead to sepsis which if not detected early can become life threatening to the patient. Nurses being the eyes for the providers and possible the first one to learn of infection should be aware of what steps are required to be taken for adequate wound care and possible prevention of sepsis related to wound management. The focus of the project was to educate the nurses on the very basics of wound types, appropriate documentation, effective communication and learning the Cerner software and along with signs and symptoms for sepsis.

Exclusion of Content

For this project, the writer feels the content was appropriate to educate the staff. According to the writer and feedback received back from the nursing staff through the project was positive and no further request for more information was made. Content was not excluded or limited to achieve the purpose of the project.

Development of Instrument, Tool or Method for obtaining Feedback

The project was started by gathering data and information by interviewing the nurses on different units. A survey/questionnaire was formatted to learn of nursing staff knowledge and skills related wound care type solutions being used, types of wounds, stages of pressure ulcers, charting, and facility policy, and wound care team awareness. After gathering the data from the surveys, the PowerPoint was planned and created. The student’s mentor approved of the PowerPoint content to be presented to the nursing staff at CCHCF. The PowerPoint was presented from unit to unit and also emailed to the nurses of other units which were not possible to be visited in person in the allotted time of the nursing practicum.

The nurses were than requested to evaluate the material presented on the PowerPoint using the survey at the end of the PowerPoint to learn of the effectiveness and need for more information or clarification of the content. The nursing staff who was emailed were able to use the survey sent along with the presentation to evaluate the effectiveness and usefulness of the content of the PowerPoint for nursing staff by emailing back to the student. Some of the staff who was emailed, printed the survey and hand delivered to the student instead of emailing.

Identification of themes/categories

Initially when the nurses were interviewed to learn of the barriers, many nurses verbalized their frustration with nurses not knowing how to document their assessment appropriately in patient chart using Cerner. For example, Nurse A stated, “One of the barriers is proper training on Cerner system for documentation on wounds”.  Another example include where Nurse B verbalized, “Nurses not knowing when to report the change in wound to the provider for treatment also delays care and leads to complications.” Many other nurses also gave their feedback which consisted of wound assessment, appropriate charting and reporting in timely manner to the providers to provide the appropriate treatment. Since adequate wound assessment and appropriate charting of the assessment are the basis of making sure patients are provided with adequate wound care and management was the main cause and direction of the project.

It is imperative that nurses are appropriately educated and knowledgeable of ways to management the wounds, when to report any changes or worsening in wounds, be able to prevent the complications, and be familiar with the facility acquired medical health record software to document appropriately. Furthermore, after the interviews, the surveys that were presented were analyzed for their results and data collection which also reflected the same findings as with the interviews from the nurse.

Chapter 4: Discussion of Findings and Recommendations

Wound Care PowerPoint Evaluation by Nurses

141 participants completed and submitted their questionnaire copied to the author for analysis. The outcomes of the nurses’ evaluation of the Wound Care PowerPoint are provided in the subsequent subheadings.

Whether the Presenter Provided Clarification on Information

Out of the 141 participants 53 participants (38%) strongly agreed that the presented provided clarification on information, 69 participants (53%) agreed that the participant provided clarification on information, 6 participants (4%) disagreed and 4 participants (3%) strongly disagreed. 9 participants (6%) were not sure of their responses (N/A). This information is exemplified in the table and figure below:

Table I: Whether the Presenter Provided Clarification on Information

Figure I: Whether the Presenter Provided Clarification on Information

Whether the PowerPoint Enhanced the Participant’s Knowledge and Information for Wound Care

When asked whether the power point enhanced their knowledge and information for wound care, 59 participants (42%) were for “strongly agree”, 68 participants (48%) were for “agree”, 7 participants (5%) were for “disagree”, and 3 participants (2%) were for “strongly disagree”. 4 participants (3%) were for not applicable. This information is shown in the table and figure below:

Table II: Whether the PowerPoint Enhanced the Participant’s Knowledge and Information for Wound Care

Figure II: Whether the PowerPoint Enhanced the Participant’s Knowledge and Information for Wound Care

Whether Participants are Familiar with Types of Wounds, s/s of Sepsis and Early Detection of Sepsis

Out of the 141 participants 63 participants (45%)strongly agreed that they were familiar with types of wounds, s/s of sepsis, and early sepsis detection, 67 participants (48%) agreed on this issue, 6 participants (5%) disagreed, and 2 participants (1%) strongly disagreed. 2 participants (1%) were unsure of their responses. This information is shown in the table and figure below:

Table III: Whether Participants are Familiar with Types of Wounds, s/s of Sepsis and Early Detection of Sepsis

Figure III: Whether Participants are Familiar with Types of Wounds, s/s of Sepsis and Early Detection of Sepsis

Whether the PowerPoint Helped the Participants with Accurate Charting for Wound Care and In Case of Suspected Sepsis

Out of the 141 participants, 63 participants (45%) strongly agreed that the power point helped them with accurate charting for wound care and in case of suspect sepsis, 69 participants (49%) agreed on this issue, 4 participants (3%) disagreed, and 3 participants (2%) strongly disagreed. 2 participants (1%) were unsure of their responses (N/A).

Table IV: Whether the PowerPoint Helped the Participants with Accurate Charting for Wound Care and In Case of Suspected Sepsis

Figure IV: Table: Whether the PowerPoint Helped the Participants with Accurate Charting for Wound Care and In Case of Suspected Sepsis

Whether Participants were Able to Apply What they Learned to Provide better Wound Care and Patient Care

Out of the 141 participants, 56 participants (38%) strongly agreed that they could apply what they learned to provide better wound care and patient care, 72 participants (52%) agreed on this issue, 6 participants (5%) disagreed, and 4 participants (3%) strongly disagreed. 3 participants (2%) were not sure of their responses. This information is exemplified in the table and figure below:

Table V: Whether Participants were Able to Apply What they Learned to Provide better Wound Care and Patient Care

Figure V: Whether Participants were Able to Apply What they Learned to Provide better Wound Care and Patient Care

Whether Participants Were Able to Locate CCHCF wound Care Policy and Procedure as Required

Out of the 141 participants, 58 participants (42%) and 69 participants (49%) strongly agreed and agreed respectively that they were able to locate CCHCF wound care policy and procedure as needed. On the other hand, 9 participants (6%) and 3 participants (2%) agreed and strongly disagreed respectively. 2 participants (1%) were unsure of their responses. This information is presented in the table and figure below:

Table VI: Whether Participants Were Able to Locate CCHCF wound Care Policy and Procedure as Required

Figure VI: Whether Participants Were Able to Locate CCHCF wound Care Policy and Procedure as Required

Whether Participants Were More Familiar with CCHCF Wound Care Guide

Out of the 141 participants, 60 participants (43%)  strongly agreed that they were more familiar with CCHCF wound care guide, 71 participants (50%) agreed on this issue, 5 participants (4%) disagreed, and 2 participants (1%) strongly disagreed. 3 participants (2%) were not sure of their responses (Not Applicable). This information is exemplified in the table and figure below:

Table VII: Whether Participants Were More Familiar with CCHCF Wound Care Guide

Figure VII: Whether Participants Were More Familiar with CCHCF Wound Care Guide

Discussion of Findings

This study employed descriptive statistics in evaluating the data acquired from participants using a survey. The limitation of the project design existed in the fact that unequal numbers of participants were employed for interviews and survey. Interviews could not be conducted with many participants, as this would lead to extremely bulky data for analysis. As such, only 6 participants were interviewed prior to the administration of the power point intervention relative to 141 participants selected for the survey. Therefore, the comparison of outcomes from the two methods of data collection was marred with incompatibility of outcomes. Moreover, owing to limitations of time and resources, this study only targeted 180 participants out of whom 141 completed and submitted their survey copies. As such, this small sample can limit the generalizability of the study findings. The recommendations for future studies are provided in the recommendations section.

The outcome of the nurses’ assessment of the effectiveness of the power point presentation on the wound care plan revealed a positive contribution of the power point presentation to equipment nurses with knowledge and skills on wound care management. The effectiveness of the power point presentation was evident in many areas. In relation whether the presenter provided clarification on information about wound care management, the outcomes revealed that 91% of the nurses or 122 nurses (sum of participants who strongly agreed and those who agreed) believed that the information o wound care management provided by the presenter was clear or clarified. On the other hand, 13% of the participants or 19 nurses believed that that the presenter was not clear or were unsure of their responses (sum of disagree, strongly disagree, and N/A), as shown it table I and figure I of the findings or results sections. These outcomes revealed that the author was effective in educating nurses using the power point presentation.

Nurses were then asked whether the power point enhanced their knowledge and information for wound care, 90% of participants or 127 nurses (sum of participants who strongly agreed and those who agreed) believed that the power point enhanced their information and knowledge of wound care. Only 10% of the participants or 14 nurses (sum of disagree, strongly disagree, and N/A) did not believe or were unsure of the impact of the power point on their knowledge and information for wound care, as shown in figure II and table II of the results section. These outcomes emphasize the effectiveness of power point presentation as an educational intervention in equipping nurses with knowledge and information about wound care.

When asked whether they were familiar with types of wounds, s/s of sepsis, and early sepsis detection, 93% of the participants or 130 nurses out of 141 nurses (sum of participants who strongly agreed and those who agreed) argued that they were conversant with early sepsis detection, s/s of sepsis, and types of wound. Only 7% of the participants or 10 nurses out of 141 nurses (sum of disagree, strongly disagree, and N/A) were unsure of their responses or stated that they were not familiar with the types of wound, early sepsis detection, and s/s of sepsis, as a shown in figure III and table III of the section of results. These outcomes reveal that the power point presentation contributed into a significant number of nurses comprehending the forms of wounds, s/s of sepsis and early sepsis detection. As such, this outcome sends a positive signal to the facility considering that identification of the early sign of sepsis and antibiotic administration increase the patient’s chances of survival as argued by Alliance (2019). In relation to whether the power point presentation helped the participants with precise charting for wound care and in situations involving suspected sepsis, 94% of the participants or 132 nurses out of 141 nurses (sum of participants who strongly agreed and those who agreed) stated that the power point assisted them with precise charting for wound care and in circumstances involving suspected sepsis. Only 6% of participants or 9 nurses (sum of disagree, strongly disagree, and N/A) argued that the power point was not helpful when it comes to accurate charting with wound care and situations associated with suspected sepsis, as shown in figure IV and table IV of the findings’ section. Nurses were then asked whether they could apply what they learned to provide better wound care and patient care. 90% of participants or 128 nurses out of 141nurses (sum of participants who strongly agreed and those who agreed) stated that they were able to apply what they learned when it comes to the provision of better patient care and wound care. Only 10% of participants or 13 nurses out of 141 nurses (sum of disagree, strongly disagree, and N/A) argued that they could not apply what they had learn to practice or were unsure of their responses, as shown in figure V and table V in the sections of results. These outcomes reveal that a significant portion of nurses could apply wound care management knowledge after the power point presentation.

Nurses were also asked whether they were able to identify or locate CCHF wound care procedure and policy as needed. 91% of participants or 127 nurses out of 141 nurses (sum of participants who strongly agreed and those who agreed) stated that they could locate the CCHF wound care policy and procedure, whereas 10% of participants or 14 nurses out of 141 nurses (sum of disagree, strongly disagree, and N/A) stated that they could locate the CCHF procedure or policy or were unsure of their responses, as shown in figure VI and table VI of the results section. Therefore, these results indicate that the administration of education via power point intervention enhanced the ability of nurses to locate the health care facility’s policy and procedure for wound care.

The last assessment question focused on whether participants were more conversant with the CCHCF wound care guide. 93% of the participants or 131 nurses out of 141 nurses agreed that they were more familiar with the wound care guide for CCHCF. Only 7% of the participants or 10 nurses out of 141 nurses stated that they were not more conversant with CCHCF’s guide for wound care or were unsure of their responses, as shown in figure VII and table VII in the section of findings. These outcomes indicate that the administration the education intervention using the power point presentation was effective in enhancing the knowledge of nurses in relation to the CCHCF wound care guide. In general it can be concluded that education intervention, especially the power point presentation, contributes significantly to enhancing the knowledge of nurses in relation to wound care management. This intervention enhances the wound care management knowledge of nurses in various areas including locating and understanding hospital’s wound care policy and procedure, comprehension of wound care guide, and comprehending types of wounds and s/s of sepsis, as well as early sepsis detection.  In relation to this, the subsequent section provides the recommendations for the facility.

Recommendations

Owing to the limitations associated with the project’s design and survey sample, the author’s future studies will focus on comparing data from equal numbers of participants from interviews and surveys. The author’s future study could also focus on using surveys only and comparing outcomes of surveys prior to the administration of the power and after the administration of the power point. Such an undertaking will ensure uniformity in the comparison of data. In relation to the project’s sample, the author’s future study will focus on large survey samples within the same health care facility to enhance the generalizability of the study outcomes. In relation to the finding of the study, the author will share the outcomes with the management of CCHCF so that appropriate implementation measures can be embraced. This information could be emailed to the health care facility’s human resource department so that it can be shared with the senior management and organizational employees prior to the implementation of education interventions on wound care management, wound care guide, and wound care management policy and procedure within the facility.

Appendices

Appendix A

Wound Care Nursing Knowledge and Skills Assessment

Instruction: - Please circle the response appropriate to your knowledge and skills related to wound care.

Self-Assessment of Knowledge and Skills

1. How confident are you with your knowledge and skills related to wound care?
   1. Very confident
   2. Confident
   3. Not confident, can use education
   4. No knowledges of wound care
2. Skin assessment is part of daily/shift nursing assessment for all my patients.
   1. Yes
   2. No
   3. I don’t know
3. I received sufficient education on chronic wounds in my basic nursing education program.
   1. Yes
   2. No
4. I am comfortable in making recommendations to practitioners on appropriate wound dressings for my patients
   1. All the time
   2. Most of the time
   3. Sometimes
   4. Never
   5. Our wound team/nurse makes the decisions
5. The following are routinely used to clean chronic wounds in the facility.
   1. 9% sodium chloride solution
   2. Povidone-iodine
   3. Commercial wound cleanser
   4. Other (please specify)__________
6. Do you know you facility’s pressure injury incidence rate?
   1. Yes
   2. No

Facility Specific Questionnaire

7. My facility has a policy for how often a wound assessment should be completed and documented.
   1. Yes
   2. No
   3. I don’t know
8. My facility has designated wound care team.
   1. Yes
   2. No
9. A computerized wound assessment is tool is used on my facility.
   1. Yes
   2. No
   3. I don’t know

Wound Care Specific Assessment

10. I can identify the six stages of pressure injuries in my patients.
    1. Yes
    2. No
    3. Sometimes (please specify)________________________________________________ _______________________________________________________
11. All patients at risk for pressure injuries should be turned and repositioned every 2 hours.
    1. Yes
    2. No
    3. I don’t know
12. Stage 1 pressure injuries are easily identified in people with darkly pigmented skin.
    1. Yes
    2. No
    3. I don’t know
13. The Braden Scale is used to assess a patient’s potential to develop a vascular ulcer.
    1. Yes
    2. No
    3. I don’t know
14. Length, width, and depth measurement should be part of wound assessment documentation.
    1. Yes
    2. No
    3. I don’t know
15. Pressure redistribution products are used in my facility to prevent pressure injuries. E.g. specialty beds, mattresses or chair cushions.
    1. Yes
    2. No
    3. I don’t know
16. I know how to apply a compression wrap/ bandaging multilayer system/dressing.
    1. Yes
    2. No-need training

Appendix B

PowerPoint Objectives

1. Introduce/explain different types of wounds
   1. Simple wounds
   2. Complicated wounds
2. Explain signs/symptoms of infection related to wounds.
   1. Compare s/s in ambulatory vs paraplegic patient
3. Introduce CCHCF wound care policy and wound care team including contact information and how to place orders in Cerner.
4. Explain ways for early detection of sepsis related to wound infection.
5. Explain ways for better communication using electronic health records (Cerner).

Appendix C

Wound Care PowerPoint Evaluation by Nurses

1. The presenter was able to provide clarification on information
2. Strongly disagree
3. Disagree
4. Agree
5. Strongly agree
6. N/A
7. The PowerPoint helped enhance my knowledge and information for wound care.
   1. Strongly disagree
   2. Disagree
   3. Agree
   4. Strongly agree
   5. N/A
8. I am now more familiar with types of wounds, s/s of sepsis and early detection of sepsis.
9. Strongly disagree
10. Disagree
11. Agree
12. Strongly agree
13. N/A
14. The PowerPoint helped me with accurate charting for wound care, and in case of suspected sepsis.
15. Strongly disagree
16. Disagree
17. Agree
18. Strongly agree
19. N/A
20. I am able to apply what I have learned to provide better wound care and patient care.
    1. Strongly disagree
    2. Disagree
    3. Agree
    4. Strongly agree
    5. N/A
21. I am now able to locate CCHCF wound care policy and procedure as needed.
    1. Strongly disagree
    2. Disagree
    3. Agree
    4. Strongly agree
    5. N/A
22. I am more familiar with CCHCF wound care guide.
    1. Strongly disagree
    2. Disagree
    3. Agree
    4. Strongly agree
    5. N/A